Acute Myocardial Infarction In Sweden Research Articles

Geographical and sociodemographic differences in statin dispensation after acute myocardial infarction in Sweden: a register-based prospective cohort study applying analysis of individual heterogeneity and discriminatory accuracy (AIHDA) for basic comparisons of healthcare quality

BackgroundIn Sweden, as in many other countries, official monitoring of healthcare quality is mostly focused on geographical disparities in relation to a desirable benchmark. However, current evaluations could be improved...

Comparison of hospital variation in acute myocardial infarction care and outcome between Sweden and United Kingdom: population based cohort study using nationwide clinical registries

Objective To assess the between hospital variation in use of guideline recommended treatments and clinical outcomes for acute myocardial infarction in Sweden and the United Kingdom.Design Population based longitudinal cohort...

Low socioeconomic status of a patient's residential area is associated with worse prognosis after acute myocardial infarction in Sweden

IntroductionPrevious studies have established a relationship between socioeconomic status (SES) and survival in coronary heart disease. Acute cardiac care in Sweden is considered to be excellent and independent of SES. We studied the influence of area-level socioeconomic status on mortality after hospitalization for acute myocardial infarction (AMI) between 1995 and 2013 in the Gothenburg metropolitan area, which has little over 800,000 inhabitants and includes three city hospitals. MethodsData were obtained from the SWEDEHEART registry (Swedish Websystem for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) and the Swedish Central Bureau of Statistics for patients hospitalized for ST-elevation myocardial infarction (STEMI) and non-STEMI in the city of Gothenburg in Western Sweden. The groups were compared using Cox proportional hazards regression and logistic regression. Results10,895 (36% female) patients were hospitalized due to AMI during the study period. Patients residing in areas with lower SES had higher rates of smoking and diabetes (P<0.001), and were also at increased risk of developing complications, including heart failure and cardiogenic shock (P<0.05). Living in an area with lower SES associated with increased risk of dying after an AMI also in models adjusted for risk factors (P<0.05). ConclusionAlso in a country with strong egalitarian traditions, lower SES associates with worse prognosis after AMI, an association that persists after adjustments for differences in traditional cardiovascular risk factors.

Target-Attainment Rates of Low-Density Lipoprotein Cholesterol Using Lipid-Lowering Drugs One Year After Acute Myocardial Infarction in Sweden

The objective of this prospective cohort study was to describe real-life use of lipid-lowering drugs and low-density lipoprotein cholesterol (LDL-C) target-attainment rates 1 year after acute myocardial infarction (AMI). LDL-C was recorded at hospital admission for AMI and at follow-up at 2 and 12 months after AMI in 17,236 patients in the Swedish heart registry, SWEDEHEART, from 2004 through 2009. Lipid-lowering treatments were identified using the Swedish Prescribed Drug Register. More than 90% of patients received statins after AMI. Simvastatin ≤40 mg was used by 80% of patients at discharge and at 2 months and 68% at 1 year after AMI. Intensive statin therapy (LDL-C-lowering capacity >40%) was prescribed for 8.4%, 11.9%, and 12.2% at these time points, and combinations of statin/ezetimibe for 1.1%, 2.8%, and 5.0%, respectively. The LDL-C target of <2.5 mmol/L (97 mg/dl) was achieved in 74.5% of patients at 2 months and 72.3% at 12 months after AMI. Treatment was intensified for only 21.3% of patients with LDL-C above target at 2 months. In multivariate analysis, higher LDL-C levels at admission and at 2 months correlated to increased risk for under treatment at 12 months after AMI. In conclusion, statin treatment after AMI in Sweden has become standard, but titration to reach recommended LDL-C levels is still suboptimal. Strategies to further improve implementation of guidelines are needed.

Oral Presentations From the WORLD CONGRESS OF CARDIOLOGYScientific Sessions 2012

HomeCirculationVol. 125, No. 19Oral Presentations From the WORLD CONGRESS OF CARDIOLOGYScientific Sessions 2012 Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBOral Presentations From the WORLD CONGRESS OF CARDIOLOGYScientific Sessions 2012Dubai, United Arab Emirates18–21 April 2012 Originally published15 Apr 2012https://doi.org/10.1161/CIR.0b013e31824fcd6bCirculation. 2012;125:e659–e740Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2012: Previous Version 1 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Madujibeya I, Lennie T, Aroh A, Chung M and Moser D (2021) Measures of Engagement with mHealth Interventions in Patients with Heart Failure: A Scoping Review (Preprint), JMIR mHealth and uHealth, 10.2196/35657 Santiago de Araújo Pio C, Chaves G, Davies P, Taylor R and Grace S (2019) Interventions to promote patient utilisation of cardiac rehabilitation, Cochrane Database of Systematic Reviews, 10.1002/14651858.CD007131.pub4, 2019:2 May 15, 2012Vol 125, Issue 19 Advertisement Article InformationMetrics © 2012 American Heart Association, Inc.https://doi.org/10.1161/CIR.0b013e31824fcd6b Originally publishedApril 15, 2012 PDF download Advertisement

Decreasing trends in the incidence of heart failure after acute myocardial infarction from 1993–2004: a study of 175 216 patients with a first acute myocardial infarction in Sweden

To investigate temporal trends in the risk of heart failure (HF) complicating acute myocardial infarction (AMI) and to determine whether these trends differ by gender or age. The national Swedish hospital discharge and death registries from 1993 to 2004 were used to calculate age- and gender-specific trends for a first episode of HF within 3 years in 175 216 patients aged 35-84 and hospitalized with a first AMI. Overall, 14.4% of patients aged 35-64 and 31.5% of those aged 65-84 with AMI in 1993-1995 had a hospital diagnosis of HF within 3 years (including the index admission). Corresponding figures for patients with AMI from 2002 to 2004 were 11.5 and 28.0%, respectively. In multivariable analyses, the risk of HF decreased by 4% per year. Having had a stroke before admission increased HF risk by 37%, diabetes increased the risk by 76% and atrial fibrillation by 80%. Patients with any kind of valvular disease had a more than doubled risk. Women had a 6% higher incidence of HF than men, whereas men with an index admission for AMI who did not develop HF had higher mortality than women. In this national sample, we observed a steady decrease in the risk of being hospitalized with HF after an AMI. However, the 3-year risk of HF remains high, with nearly one-third of AMI patients aged 65-84 developing HF within 3 years.

Equal access to treatment? Population-based follow-up of drugs dispensed to patients after acute myocardial infarction in Sweden

The establishment of national guidelines is one approach to creating equity in terms of access to care, and both internationally and in Sweden, guidelines have been developed for coronary heart disease. We have analysed drug treatment in Sweden according to national guidelines after acute myocardial infarction (AMI). The aim was to investigate whether there are differences between population groups according to sex, education, country of birth and diabetes. Information was obtained from the Swedish Prescribed Drug Register on drugs dispensed between July and October 2005 for incident cases of AMI during the period 2003-2004 (n=28,168). Data on socio-economic and demographic conditions were included. Dispensed drugs after AMI were compared to the recommended drug treatment according to Swedish and European guidelines--acetylsalicylic acid (ASA), beta-blockers, lipid-lowering drugs and angiotensin-converting enzyme inhibitors (ACE inhibitors). We found that, in general, there were only small differences between the sexes and between educational groups. The greatest differences were found in comparisons between regions of birth. In particular, foreign-born patients resident in Sweden but originally from outside the EU25 countries used fewer drugs than Swedish-born patients. The OR (odds ratio) for ASA was 0.73 [95% confidence interval (CI) 0.63-0.85], for beta-blockers, 0.72 (0.63-0.83), for lipid-lowering drugs, 0.75 (0.65-0.86) and for ACE inhibitors, 0.76 (0.67-0.86). In general, we found only slight differences--or none at all--between population groups in terms of drug treatment after AMI. Only among immigrants from outside the EU25 countries was there a tendency towards a lesser use of the recommended drugs according to the national guidelines.

Attack rate, mortality and case fatality for acute myocardial infarction in Sweden during 1987-95. Results from the national AMI register in Sweden.

To assess trends in attack rate, mortality and case-fatality of acute myocardial infarction (AMI) in Sweden. All 303 324 Swedes discharged from hospitals, or deceased, with a diagnosis of AMI between 1987 and 1995. Analysis based on the National AMI Register in Sweden. The National AMI Register was assembled by linking the records of the National Hospital Discharge Register and the National Cause of Death Register in Sweden. Age-standardized attack rate, mortality and case fatality rates for AMI. Between 1987 and 1995, the age-standardized attack rate of AMI declined by 11% for men and 10% for women, whilst mortality from AMI decreased by 14% for both sexes. The decrease was most pronounced for men below the age of 64, with a reduction of 22% in attack rate and nearly 30% in mortality. There was no change over time in the case fatality rates on the date of attack, including also deaths outside hospital, whilst case fatality within 28 days decreased from 49 to 45% amongst men, and 45 to 42% amongst women. This reduction persisted over 1 year of follow-up. The decrease in attack rate of AMI in Sweden may be attributed both to changes in risk factors amongst the population and to improved medical intervention. The decline in case fatality rates indicates that improved treatment of patients with AMI has contributed to the reduction in mortality. However, the high, and essentially unchanged, proportion of deaths outside hospital stresses the importance of disease prevention.

A survey of treatment routines and educational level of health care providers in the initial phase of suspected acute myocardial infarction in Sweden in 1994. Swedish Working Group on Early Heart Attack Care.

The aim of this survey was to explore treatment routines with regard to early heart attack care at various hospitals in Sweden. All the hospitals in Sweden with a coronary care unit or its equivalent were sent a postal enquiry about early heart attack care including use of various medications and educational level of health care providers. In all, 84 of 86 hospitals (98%) answered the enquiry. Prior to hospital admission, 10% of the hospitals used thrombolytic agents, 10% used beta-blockers and 55% used aspirin. In only 4% of hospitals was thrombolytic treatment initiated in the emergency department and in 17% beta-blockers were initiated. The proportion of acute myocardial infarction (AMI) patients who received thrombolytic treatment varied from 10% to more than 80%, with a mean value of 41%. The proportion of AMI patients who received intravenous beta-blockade varied from 0 to 93%, with a mean value of 24%. This survey indicates that the vast majority of hospitals in Sweden use thrombolytic agents in more than 30% of AMI patients and aspirin in more than 80% of AMI patients. The use of intravenous beta-blockade is lower than expected. Considering the strong association between the delay before instituting therapy and outcome, it is surprising that treatment is not initiated more frequently outside hospital or in the emergency department.